This article describes the interactions of parents and their infants with visual impairment, infants who are deaf or hearing impaired, and sighted and hearing infants during play situations. Findings indicate that parents developed certain types of exchange routines that match the developmental and sensory status of their infant. Adaptation of exchange-routines may represent an analogue of so-called “caregiver speech” at the pragmatic and contextual level. Included in this article are intervention suggestions for engaging these infants in early play interactions.